David H. Baker

NECROTIZING ENTEROCOLITIS IN THE PREMATURE INFANT.

Necrotizing enterocolitis as a usually fatal disease of premature infants has been reported with increasing frequency in recent years, primarily in Europe (2, 11, 12, 14, 15, 23). Though the published cases have appeared under diverse titles including neonatal appendicitis (4, 18, 22), peritonitis (12), colitis (21), ileitis (1), pneumatosis intestinalis (20), or portal vein gas in infants (10, 24), we feel all reflect a basically similar disease process. The current report is based on a study of 21 cases of enterocolitis in newborn premature infants seen between 1954 and 1964; 7 were found in a six-month period in 1963. A more detailed study of the clinical and pathologic findings will be reported separately (9). Clinical Features More than 2,000 infants were admitted to the premature nursery of The Babies Hospital from 1954 to 1964. Seventeen died of enterocolitis (0.9 per cent), and 4 survived. Usually weighing under 1,500 grams at birth, the babies showed a similar clinical pattern. They seemed well d...

Tamm-Horsfall Proteinuria Its Relationship to Prolonged Nephrogram in Infants and Children and to Renal Failure Following Intravenous Urography in Adults with Multiple Myeloma!

A prolonged tubular nephrogram lasting hours to days has been seen in performing excretory urography in a group of infants and children. The patients shared in common some degree of oliguria but all were normotensive throughout the period of study and had calyces of normal caliber, indicating a precalyceal accumulation of contrast material. Large amounts of Tamm-Horsfall (T.H.) urinary mucoprotein (16) were subsequently found in several of the patients once diuresis occurred (Table I). This mucoprotein is of importance since it has been shown to form a viscid gel with resultant tubular blockage in conditions of oliguria or dehydration. It has been found not only in casts of patients with varying types of renal disease, but it even forms the main part of casts in multiple myeloma patients dying in renal failure (5–8). The clinical features and radiographs of the pediatric patients are reviewed in the light of known knowledge of T.H. protein (4–8, 13). Preliminary in vitro testing of this protein with curre...

Midgut Malrotation and Volvulus

Abstract Midgut malrotation is a surgical emergency usually seen in the first weeks of life. It presents with duodenal obstruction and bile emesis; the signs may be intermittent or minimal. The advantages and limitations of plain films, barium enema studies, and gastrointestinal studies were reviewed in 77 patients with malrotation; volvulus was seen in 65. Additional experience was gained from a questionnaire among members of the Society for Pediatric Radiology. Barium enema studies were preferred by 39 respondents. The upper gastrointestinal series was useful in defining extrinsic duodenal obstruction, but was difficult to interpret if the patient was asymptomatic when studied.

Upper airway obstruction in infants and small children. Improved radiographic diagnosis by combining filtration, high kilovoltage, and magnification.

Selective filtration, high kilovoltage, and fine focal spot magnification produce detailed radiographs of the airway of infants and small children. This technique has been applied to the study of upper airway obstruction in the glottic, subglottic, and supraglottic areas. Its great diagnostic yield is accompanied by a reduction in radiation dose compared to that of a nonfilter technique. The physical factors dictating choice of filter and film-screen combination are discussed.

Scrotal Masses in Healed Meconium Peritonitis

MECONIUM peritonitis, representing in utero perforation of the gastrointestinal tract, is usually associated with neonatal intestinal obstruction, secondary either to atresia, volvulus, or adhesion...

Microcolon in Newborn Infants with Intestinal Obstruction

Microcolon is the radiologic finding of a colon of tiny caliber on barium-enema examination of newborn infants with intestinal obstruction. It signifies only that the obstruction is above the colon. Barium-enema studies have shown that many infants with intestinal obstruction above the colon do not have “microcolon.” This finding led to a review of the size of the colon in newborn patients with all levels of intestinal obstruction. The colon caliber has been correlated with both the level and the time of onset of the fetal intestinal obstruction. Factors Normally Dilating the Fetal Colon The fetal gastrointestinal tract is a site of active work throughout the last two trimesters of pregnancy (1). The fetus actively swallows amnion, and this fluid load, estimated at several liters a day, mixes with gastric juice, bile, and the desquamated intestinal cells and succus entericus to form meconium, the feces of the fetus. Normally, the mixture becomes less fluid in the lower small bowel as amnion is absorbed; t...

Neonatal Small Left Colon Syndrome: Its Relationship to Aganglionosis and Meconium Plug Syndrome

Neonatal small left colon syndrome is a cause of functional colon obstruction in newborn infants, with a high association of maternal diabetes. There has been much confusion regarding its relationship to meconium plug syndrome and aganglionosis. Six cases of aganglionosis (2 in infants of diabetic mothers) were encountered in which the radiographic findings were identical to small left colon syndrome, indicating the need for caution in dismissing aganglionosis solely on the basis of a small left colon seen radiographically in a newborn infant with colon obstruction. Small left colon and meconium plug syndrome are overlapping entities in the total spectrum of functional intestinal obstruction in newborn infants.

Innominate Artery Compression of the Trachea in Infants with Stridor and Apnea

Compression of an infants trachea by the innominate artery (Fig. 1) may cause stridor, cyanosis, apnea, and even death. This was recognized by Gross and Neuhauser (3) in 1948 when they reported surgical relief of these symptoms by suturing the “anomalous” artery to the sternum. The “anomaly” drew virtually no attention in the next decade until the report of Fearon and Shortreed in Toronto (1). They diagnosed such compression on the basis of endoscopic findings in more than 300 infants and children. More than 10 per cent of the patients had enough respiratory problems in addition to stridor to require surgery (1, 2). Angiographic findings were shown by Maurseth (7) in 1965. He also noted that the symptoms disappeared with increasing age in cases in which no operation was performed. This report will emphasize a simple plain film technic that has allowed this diagnosis to be made in 5 cases, all confirmed by angiography. Since not all patients needed surgery and not all patients operated on benefited from s...

The radiologic evaluation of imperforate anus. An approach correlated with current surgical concepts.

In 1930 Wangensteen and Rice (9) introduced the still widely used technic of obtaining upside-down abdominal roentgenograms in newborn infants with “imperforate anus.” They made no measurement of any type, but merely employed the apparent distance between the rectal gas and anal dimple in planning surgical therapy. Subsequently, various measurements were devised including a distance of 1.5–2 cm between the rectal gas and anal marker; if this distance was exceeded, the perineal approach for correction was not used. Bony reference points were also considered (5), including the pubococcygeal line and ischial point (8); if the gas terminated above the pubococcygeal line, the perineal approach again was not advised. All these methods obviously were aimed at guiding the surgeon by placing patients into two major groups: those amenable to repair by the perineal route (“low”anomalies) and those not approachable solely from the perineum (“high” anomalies) (4, 6, 8). A basic assumption was implicit in all previous ...

Prolonged Jaundice as Presenting Sign of Massive Adrenal Hemorrhage in Newborn: Radiographic Diagnosis by IVP with Total-Body Opacification

Abstract The basis of radiographic diagnosis of massive adrenal hemorrhage in newborn infants with abdominal masses and jaundice should be the high-dose intravenous urogram with total-body opacification. This reveals sharply defined avascular adrenal masses, with or without early calcification, that flatten and shift the kidney. Three cases are presented in which jaundice representing hemolysis within a closed space was the striking clinical finding that led to radiographic studies. Differential diagnoses include renal duplication, usually with ectopic ureteroceles, neonatal neuroblastoma, and the rare Wolmans familial xanthomatosis with adrenal calcification.